WHENEVER I encounter someone on the street, in a store, or any other public place, the usual refrain is, “Hello Doc, I have to come in to see you for a cleaning”. Now I do not find that strange at all. Most likely, it is because a cleaning (prophylaxis) is commonly seen as the most painless dental procedure. What people do not generally know is that cleaning constitutes prevention of almost all of the most common dental ailments.

Of all eight specialist fields in dentistry, more dentists pursue a speciality in periodontics than any other. A primary reason likely has to do with the fact that gum disease is a major problem people face. What places it probably among the most dangerous of all oral diseases is the fact that it is insidious and painless, while being the main reason why people lose their teeth.
Gingivitis represents the characteristic host response to bacterial plaque. It is the most common form of periodontal disease and may affect over 90% of any population.

The lesion is usually confined to the gum margin and is observed locally or generally. Gingivitis may persist for years without further progressing into supporting periodontal structures. However, in animal modules, gingivitis always precedes periodontitis and may be considered a prerequisite for disease initiation. Symptoms include red, shiny, swelling, and often painful gums, especially around the neck area of the teeth affected.
The best thing about periodontitis is that it is preventable. Prevention is achieved by thorough and proper brushing, flossing, eating an adequate diet, and having regular dental checks.

Adult periodontitis is the most prevalent form of periodontitis. It is usually a chronic disease emerging from its precursor, namely gingivitis, due to long-standing plaque accumulation. Since not all gingivitis appears to progress to periodontitis, specific bacteria have been postulated to account for the various disease progression in various individuals.

The periodontal lesion is characterised by loss of connective tissue fibre attachment to the root surface. The progression of attachment loss was, for a few years, considered to occur in episodes of activity bursts. However, this concept has not been unanimously accepted, and the theory of this mode of progression may be explained based on measurement error using special probes. Symptoms include the presence of a deep pocket between the gum and the tooth, bleeding and shaking of the affected teeth.

With early onset, periodontitis disease forms are grouped according to the prevalence of the conditions, which can be defined by the patient’s relatively young age and/or specific local causative factors. They occur during childhood or adolescence and affect less than one percent of the population. Two groups
have been characterised by the World Workshop of the American Academy of Periodontology.

Prepubertal periodontitis and juvenile periodontitis appear both in localised and generalised forms. The major clinical features are severely advanced lesions with bleeding when irritated, pus formation, and deep pockets between the gum and affected tooth, but with relatively small plaque deposits at an early age.
Finally, necrotising periodontitis is usually accompanied by ulcerative lesions and appears to progress rather dramatically. Necrosis of the gum projecting between adjacent teeth and of the bone from the ridge may be observed. The major signs are profuse bleeding, pocket formation, gum retraction and bad breath.